I had my 3 month post RP visit at UPENN yesterday. I thought for sure that I would be meeting with the surgeon's PA. But, I was pleasantly surprised to see Dr. Lee himself. He spent about 10-15 minutes with me and answered all of my questions. My main non-PCa issue was ED. And he said where I am now (total ED) is not uncommon and to continue to work on rehab. He told me it could take up to 2 years, but that I should start to see incremental improvement prior to that.

Now, onto the PCa issue. Dr. Lee told me that I had a very small positive margin, and that in itself, minimally impacts that probability of BCR. The EPE, or ECE as he called it, plays a 5-10% increase in the probability of BCR in cases like mine. However, he was pleased with my first uPSA of <.006 and basically told me to go live my life and I'll see you in 9 months. No further treatment at this time. Of course, I have 3 month uPSA's, but these results will just be electronically sent to his office and available to me online. I guess we'll act if it starts creeping up.

Here is my conundrum.....I have an email buddy whose pathology is similar to mine. RP about the same date, same 4+3, similar initial low PSA (mine was 2.5), same positive margin, but I had EPE and he did not. So, my pathology is actually worse. He is getting guidance to start RT now and I am not. Am I being under treated by not getting RT now? Should I be trying to kick this is the *** now and start RT? Is he potentially being over treated? Is there any down side to waiting for PSA to increase before starting RT?

I got a good start to treating my PCa. But I don't want to fall behind. So, as the song goes, "Should I stay or Should I go"?.......with RT now?

Personally, with what I understand about your case, I would wait until there is at least a shread of evidence that salvage RT is needed. With 4+4/4+3, it may be needed some day, but maybe 5-years down the road. Maybe in 6-months.

There are superb urologists and ROs who jump on SRT with your pathology and others who wait - some for .01, some for .02.

Based on what I've seen and read, and knowing that in any case we've a limited number of years of life, in your shoes I would follow your MD's advice (as I have mine). At this point I'm getting a great response from diet alone, and enjoying the months without SRT appointments or SEs.

To mitigate side effects of surgery, radiation treatment should not start until the healing has been complete, at least three months. Generally speaking, whatever your side effects are when radiation starts they will not get any better and usually will get worse. Now if you were high risk, or the initial PSA showed a surgical failure, then that timeline could be sped up and you have to weigh cancer control versus side effects.

I think to rush to SRT now would potentially be overtreatment and certainly would arrest any continued improvement of the healing process. Give things a chance to work. If it were me I would stay on a shorter timeline with PSA tests, at least every 90 days. That will tell you a lot and will put your mind at ease. If in 90 days your PSA has started going up it will likely signal a failed surgery that now requires SRT. If it is stable, it will show increased evidence of a successful surgery, but not yet a confirmed cure.

You are data driven, and I think you will do better by having more frequent PSA tests than it looks like your urologist is suggesting. Either have your PCP pull the blood or just go to the many "anytime testing labs". PSA doesn't cost much to get and you usually don't need a doctor to order the test.

And......relax. You are off to a very good start.PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.PSA < .1 since February 2011

Agree with Jack and the others. You don't want to go the ADT/SRT route unless it is clearly indicated. With SRT your pelvic lymph nodes will probably be turned into mush which then leads to lymphodema - fluid accumulates in your legs. I use a pneumatic compression device for an hour every day and wear support hose during waking hours. My legs ache almost all of the time. I won't even talk about ADT - you don't want to go there unless absolutely necessary.DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)da Vinci RP on March 2, 2015---------------------Stage pT3aN17/01/2016 PSA < 0.017/31/2015 HT started - six month's injection of LuperonART 11/2015, 33 session

What your friend is getting is called "adjuvant radiation." That means he is getting radiation soon after surgery and without waiting for a PSA to make his decision. There have been 3 major clinical trials that proved that adjuvant radiation had better results than waiting until after an "official" biochemical recurrence happened (at a PSA≥0.2). But a LOT of patients would be overtreated by getting adjuvant radiation when they didn't really need it. And a lot of patients don't need it and would never progress. So, what to do?

One solution is called "early salvage radiation." That means waiting until an ultrasensitive PSA test indicates that a full-blown biochemical recurrence is bound to happen. For guys like you, with adverse pathology findings, that uPSA level seems to be about 0.03 ng/ml. Treating at a lower uPSA is often over-treating. And treating when the uPSA hits 0.03 reliably (97% of the time) predicts that the PSA will eventually rise to a full blown biochemical recurrence, and it gives you 18 months lead time over waiting for PSA to hit 0.2.

I think maybe overtreatment is more common in US than here in Europe due to our different health care systems. It could be that patients are more likely to get therapy when it financially benefits their care givers (as in US) but that should not not the case in countries with public care systems (as in EU). On the other hand undertreatment could be more common in EU due to that the care givers chasing the lowest cost. Thresholds for triggering treatment seems often to be higher in EU guidelines than the what we read in studies referenced by TA. Just a thought.Age at detection 60PSA 4.1 2014-02-25Biopsy 2014-04-24, 4 of 10 cores positive, G: 3+4,4+3,4+3 EPE,4+3. PNIBone scan negativeDaVinci 2014-08-31, nerve sparing right sideProstate 35 g, 46x37x38 mmTumor dorsal PZ, SV-, 14 neg nodes, Margins -, pT3a, G7 (4+3), EPE left sidePSA:2014-10-16 <0.05 2016-03-31 <0.052015-03-04 <0.05 2016-09-06 <0.052015-09-08 <0.05

the way i understand it is that the lower risk guys have the most to gain with adjuvant. But as TA's studies point out that comes with higher over treatment rates as well. pick your poison. it's my urologist's group's standard protocol to zap you with any adverse findings at all. but it's their job cure cancer....darn the torpedoes.

I've decided to wait until I know I need it before volunteering for anymore major, proactive, medical treatments. But, that's me.

I would like to point out what JNF said:"To mitigate side effects of surgery, radiation treatment should not start until the healing has been complete".

He is right. JayMot writes: "My main non-PCa issue was ED". If radiation is done now, healing will not be complete yet and the ED will usually persist forever. Radiation will damage the nerves even further.

2 weeks after my RP my PSA was 0.2 so I started ADT. 3 months later I started 2 months of daily EB radiation - 80 Gy total. After 3 years of ADT chemo it took my poor pituitary almost a year to get my testosterone up to 184.6 ng/dL. My PSA went up to 0.03 immediately. Go ahead and be as careful as you want to, I went ahead and got the full 9 yards and it still appears extremely likely that I will be dealing with this for the rest of my life. Glad I got the "adjuvant" radiation treatment right away.